Broken System: Levels of Care

Where a child is placed, and how many times a child is moved, depends in part on the child's Level of Care.

In 2003, the Department of Family and Protective Services streamlined the six-tier LOC system to four levels: basic, moderate, specialized and intense. Depending on the LOC, a child can be placed with a foster family, a group home or a residential treatment center. A foster child's per-diem rates to the family or institution housing him are based on the LOC; the higher the level, the higher the payment.

The levels are assigned by an Arlington-based nonprofit called Youth For Tomorrow. Based on YFT's most recent available tax forms, its sole client is DFPS. About half of the company's $1.4 million 2010 state contract goes to the services of 14 "clinical healthcare consultants." According to contract reports from 2008 and 2009, these consultants include licensed master social workers. The consultants conduct quarterly reviews for specialized/intense kids and annual reviews of kids at the basic level. (Caseworkers and others have the ability to appeal an assigned LOC.)

The rest of the contract money goes to Executive Director Ed Liebgott and his wife, Database Manager Margaret Liebgott, along with a records manager and two "program directors" for field services and intake and office services.

For a taxpayer-funded contractor that affects the lives of thousands of children in the state's care, YFT is a rather vague entity. Liebgott declined to answer any questions, referring the Houston Press to the department. But when the Press asked department spokesman Patrick Crimmins about certain statements on the company's annual reports, he referred us back to YFT for some questions and provided incomplete answers for others.

For example, the department's Public Private Partnership committee, charged with recommending changes for the foster system redesign, wrote in a January 2011 report that their recommendations were based in part on data culled from a Child Protective Services case management system called Impact.

But in the company's 2009 report, it noted that its staff "reported many situations in which CPS staff went into Impact and changed service authorizations and effective dates of YFT's data...In our judgment, this practice contributes to great confusion about the integrity of YFT's data."

The report also expresses concern that CPS supervisors and caseworkers in Travis County, apparently unsatisfied that the children in their charge were assigned lower levels of care, were "using the courts to obtain intense services [the highest level] for CPS children. In our judgment, this practice 'high-jacked' the Texas Service System."

In an e-mail to Crimmins, the Press cited the 2009 report and asked about these concerns. Crimmins replied that, "...we don't know exactly where this quote appears. It appears to be the opinion of the Executive Director of YFT, not an independent audit. If a court issues an order, whether that pertains to a service level or any other type of order, DFPS is obligated to comply. We don't have any evidence that Travis County caseworkers and supervisors were utilizing the court system to order a specific service level."

Crimmins also dismissed the company's allegation that CPS staff were altering data, writing that "caseworkers do not have the security access to be able to change or edit any service level authorization."

But if that's the case — that YFT is so delusional as to think certain caseworkers are altering service levels without authorization — why does the department repeatedly renew the company's contract? And why would the department not be familiar with its contractor's annual report?

One reason kids in the Permanent Managing Conservatorship are moved so often is that levels of care, while necessary, are extremely fluid. And because YFT staff rarely meet the children they label, what might look on paper like an appropriate LOC may not actually align with the reality of a given situation.

Take 21-year-old Daniel McGary, who first entered the system when he was five, was reunited with his mother when he was nine and then went back into the state's care at age 11. (He entered with two half-brothers and a sister; the brothers were placed in their biological father's home. He and his sister stayed in an emergency shelter until they were assigned different LOCs and sent to different foster homes.) He left his last foster home at age 17 — technically a runaway — to move in with a friend. Less than a year later, he aged out of the system.

Born in the small town of Quanah, McGary got to see a lot of Texas in his six years in PMC: Abilene, Lubbock, Houston, Dallas-Fort Worth, Midland-Odessa, Vernon, Witchita Falls, Waco.

When he was around 15, he wound up in a Houston foster home that he says was able to accommodate 12 foster children because the parents and three biological daughters all shared a bedroom.

The fridge and pantry were chain-locked, and the fosters ate ramen noodles while the family ate steak. He says the foster mom paid him to help her write the required daily logs, making sure to fudge them enough so that kids who were actually well-behaved appeared to be half-delinquent, so that LOCs remained moderate instead of dropping to basic. A kid got caught smoking, say, or two got into an ugly fight. In 2005, the per-diem for moderates and basics was $35 and $20 respectively. Multiply that by 12 kids, and that's a $5,400 monthly difference between service levels.

It was not an abusive home; the parents were not especially mean. But it wasn't fun being reminded every day that he belonged to a lower caste.

"There was just this huge disparity between the way they [treated] their biological children and the way they treated us," he says. "And you just get sick of it."

He figured he might as well be on his own, so he split. But he didn't get very far; when he was caught, his level of care was raised. So he was sent to the Krause Treatment Center, a lockdown facility in Katy.

McGary says Krause staff relied on fear to keep kids in line.

"The environment that they create is: 'Don't talk back, or you'll end up on the floor. Do what I say, don't give me a hard time, because I can give you an even harder time,'" he says.

And some of the kids may have known this was not a hollow threat: Four years before McGary came to Krause, three staff members there piled on an allegedly violent 14-year-old girl in an attempt to restrain her. Which they did, ultimately, by crushing her windpipe. Although her death was ruled a homicide, the three staff who actually laid on the girl, and the one who stood by and supervised, were no-billed by a grand jury. (Some Krause staff still seem to have trouble with the whole restraining thing; DFPS records show that, in the last two years, "two female staff watched and failed to render aid or assistance as a male staff member conducted a restraint alone on a female resident"; "residents and staff members witnessed a staff member hit a child in care on a vital area of the body as a form of punishment"; "staff member conducted an improper restraint by laying on top of a resident on the ground, which put pressure on the resident's torso and impaired the breathing"; and, related to another incident, "a staff member interfered with a Licensing investigation by requesting that residents write disclosure forms that proclaim the staff member's innocence in the allegations of this investigation.")

Krause spokesman Scott Carroll says the management at the center has changed since McGary was there. "Different management, different philosophy style, different therapeutic techniques."

He also says, of kids sent to Krause, "by the time they get to the Krause Center, one, they haven't been able to get the specialized help that they really need; two, they all arrive in tough, tough, hard-to-imagine life situations, otherwise they wouldn't be there — through no fault of their own."

McGary says his time in Krause was one of the lowest points in his life. Suddenly, a chain-locked refrigerator didn't seem so bad.

If there's one thing about the system he could change, McGary says it would be ensuring that LOCs are assigned by people who've actually met the child whose future they're deciding.

"Imagine if you were at a moment where you were at your most vulnerable; you've been taken from your family, placed in a shelter," he says. "You're surrounded by [strangers]...the first 30 days in that shelter, the staff will be taking logs on your behavior, how you interact with peers. All these things are large contributing factors in your level of care. I don't like the idea of someone who's never seen me, never interacted with me, never had anything to do with me reading 30 days of paperwork about me and determining from that whether or not I deserve to live with a family or [if] I should go to a residential treatment center. I think that placement issues should be decided by people who are directly involved with these kids. It just doesn't make sense to me..."

YFT's contract is up for renewal in ­August 2011.

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